1. MA Center for Health Information & Analysis Case Mix User Workgroup May 24, 2016

2. Agenda  Announcements: Slides from Previous Workgroups Now Posted FY2015 Release Information Overview of Revised Application Forms  Presentation: Acute Hospital Profiles – CHIA’s Health Analytics & Finance Team  Q&A

3. User Group Slides Posted [http://www.chiamass.gov/ma-apcd-and-case-mix-user- workgroup-information/]http://www.chiamass.gov/ma-apcd-and-case-mix-user- workgroup-information/] Based on feedback, grouped by topic and not date of meeting Three categories: Application Questions (“When do fees need to be paid?”) Questions from Users – one PDF containing multiple questions (mostly short questions/answers with 1 or 2 slides each) Tutorials – PDFs for each tutorial – hyperlink on the website will say what each tutorial is (Example: “How to Count Patients Admitted from the Emergency Dept. in the HDD file”)

4. Case Mix FY15 Release We are accepting applications for FY15 Case Mix data NOW Inpatient Data is scheduled to be ready for release on 6/30  Outpatient Observation ready in August  Emergency Department ready in September Apply for all files now and we will fulfill them as they become available. FY15 Case Mix data in LDS format FY04-FY14 available in old “Levels” format (can request on the same application form) FY15 Release Documentation will be posted next month

5. Case Mix Limited Dataset (LDS) Goal: Protect patient privacy Starting with FY2015 o Applies to non-government users only; government users may request additional elements o Revised application form is available now Changes are not retroactive to prior years of data DUAs and Data Management Plans are still required No changes in fees

6. CHIA Methodology Determined what must be excluded, including HIPAA-defined direct identifiers Investigated elements that potentially should be excluded due to patient privacy concerns (example: free text fields) Exclude certain quasi-identifiers, which make individuals unique in the population and thus could possibly be used for indirect re- identification Ended up with a “Core” LDS available to all applicants and offer “buy-up” options for date granularity, geographic granularity, and physician ID#

7. Revised Application Forms Posted here: http://www.chiamass.gov/case-mix-application- documents/http://www.chiamass.gov/case-mix-application- documents/

8. Revised Data Management Plan Posted here: http://www.chiamass.gov/assets/Uploads/data- apps/Data-Managment-Plan-for-Non-Government-Entities.docxhttp://www.chiamass.gov/assets/Uploads/data- apps/Data-Managment-Plan-for-Non-Government-Entities.docx

9. QUESTIONS?

10. ACUTE HOSPITAL PROFILES HEALTH ANALYTICS AND FINANCE (HAF) Case Mix User Workgroup | May 2016

11. Acute Hospital Profiles Uses various CHIA data resources to “profile” each acute hospital (n= 65) Utilization, services, quality, revenue trends and financial performance are all included Published annually

12. Case Mix data was aggregated at the organization level  Case Mix Index (CMI) and Case Mix Adjusted Discharges (CMAD)  Readmissions  Top DRGs: Most frequently seen inpatient cases  Top Communities: Where a hospital draws its patients Acute Hospital Profiles: Case Mix uses

13. CMI – APR DRG v.30; MA specific weights CMADs – Multiplied CMI to the hospital’s discharges as reported in their hospital cost report.  Gives an idea of “apples to apples” discharges  Cost report discharges used for consistency Acute Hospital Profiles: Case Mix uses

14. Most Frequent DRGs  Used SAS to pull DRG codes with highest number of discharges at each hospital, ranked in ascending order  Also tallied percentage of region each DRG represented  Total hospital discharges compared to region total Acute Hospital Profiles: Case Mix uses

15. Top Communities  Cross-walked zip codes to community names using U.S. Postal Service data  Calculated what percentage of the hospital’s discharges came from each community  Also looked at what percentage of each community were discharged from each acute hospital

16. Challenges: Discrepancies between Case Mix and other data sources Varying DRG code use e.g., Athol had 100% of Central MA’s rehab discharges Hospital Mergers

17. Questions?

18. Questions related to APCD : (apcd.data@state.ma.us)apcd.data@state.ma.us Questions related to Case Mix: (casemix.data@state.ma.us)casemix.data@state.ma.us REMINDER: Please include your IRBNet ID#, if you currently have a project using CHIA data

19. Call for Topics and Presenters If there is a TOPIC that you would like to see discussed at an MA APCD or Case Mix workgroup, contact Adam Tapply [adam.tapply@state.ma.us] If you are interested in PRESENTING at an MA APCD or Case Mix workgroup, contact Adam Tapply [adam.tapply@state.ma.us] You can present remotely from your own office, or in-person at CHIA.